BILL NUMBER: SB 816	CHAPTERED  10/10/99

	CHAPTER   749
	FILED WITH SECRETARY OF STATE   OCTOBER 10, 1999
	APPROVED BY GOVERNOR   OCTOBER 7, 1999
	PASSED THE SENATE   AUGUST 31, 1999
	PASSED THE ASSEMBLY   AUGUST 26, 1999
	AMENDED IN ASSEMBLY   AUGUST 23, 1999
	AMENDED IN ASSEMBLY   JULY 15, 1999
	AMENDED IN SENATE   APRIL 22, 1999

INTRODUCED BY   Senator Escutia

                        FEBRUARY 25, 1999

   An act to amend Sections 2836.1, 2836.2, 3502.1, 4040, 4060, and
4174 of the Business and Professions Code, and to amend Sections
11026 and 11150 of the Health and Safety Code, relating to health
care practitioners.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 816, Escutia.  Physician assistants and nurse practitioners.
   Under existing law, a physician assistant may administer or
provide medication to a patient, or transmit orally, or in writing on
a patient's record or in a transmittal order, a prescription from
his or her supervising physician and surgeon to a person who may
lawfully furnish the medication or medical device, as specified.
Existing law prohibits a physician assistant from administering or
providing a drug or medical device or transmitting a prescription for
a drug or medical device, except as specified, without an order from
a supervising physician and surgeon for the particular patient.
   This bill would add provisions defining a "drug order" as a
prescription issued and signed by a physician assistant acting as an
individual practitioner, as specified, and would provide that the
order be treated in the same manner as a prescription from the
supervising physician.  The bill would require advance approval from
a supervising physician prior to a physician assistant administering,
providing, or issuing a delegated prescription for Schedule II
through Schedule V controlled substances.
   The bill would require all physician assistants who are authorized
by their supervising physicians to issue delegated prescriptions for
controlled substances to register with the United States Drug
Enforcement Administration (DEA), as specified.
   Existing law authorizes a nurse practitioner to furnish drugs or
medical devices, as specified, pursuant to standardized procedures.
   This bill would add provisions defining a "drug order" as an order
for medication which is dispensed to or for an ultimate user, issued
by a nurse practitioner as an individual practitioner, as specified,
would provide that the order be treated in the same manner as a
prescription of the supervising physician and surgeon, and would
require all nurse practitioners who are authorized pursuant to these
provisions to furnish or issue drug orders for controlled substances
to register with the United States Drug Enforcement Administration.
The bill would set forth the intent of the Legislature, and make
conforming changes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 2836.1 of the Business and Professions Code is
amended to read:
   2836.1.  Neither this chapter nor any other provision of law shall
be construed to prohibit a nurse practitioner from furnishing or
ordering drugs or devices when all of the following apply:
   (a) The drugs or devices are furnished or ordered by a nurse
practitioner in accordance with standardized procedures or protocols
developed by the nurse practitioner and his or her supervising
physician and surgeon under any of the following circumstances:
   (1) When furnished or ordered incidental to the provision of
family planning services.
   (2) When furnished or ordered incidental to the provision of
routine health care or prenatal care.
   (3) When rendered to essentially healthy persons.
   (b) The nurse practitioner is functioning pursuant to standardized
procedure, as defined by Section 2725, or protocol.  The
standardized procedure or protocol shall be developed and approved by
the supervising physician and surgeon, the nurse practitioner, and
the facility administrator or his or her designee.
   (c) The standardized procedure or protocol covering the furnishing
of drugs or devices shall specify which nurse practitioners may
furnish or order drugs or devices, which drugs or devices may be
furnished or ordered, under what circumstances, the extent of
physician and surgeon supervision, the method of periodic review of
the nurse practitioner's competence, including peer review, and
review of the provisions of the standardized procedure.
   (d) The furnishing or ordering of drugs or devices by a nurse
practitioner occurs under physician and surgeon supervision.
Physician and surgeon supervision shall not be construed to require
the physical presence of the physician, but does include (1)
collaboration on the development of the standardized procedure, (2)
approval of the standardized procedure, and (3) availability by
telephonic contact at the time of patient examination by the nurse
practitioner.
   (e) For purposes of this section, no physician and surgeon shall
supervise more than four nurse practitioners at one time.
   (f) Drugs or devices furnished or ordered by a nurse practitioner
may include Schedule III through Schedule V controlled substances
under the California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) and
shall be further limited to those drugs agreed upon by the nurse
practitioner and physician and surgeon and specified in the
standardized procedure.  When Schedule III controlled substances, as
defined in Section 11056 of the Health and Safety Code, are furnished
or ordered by a nurse practitioner, the controlled substances shall
be furnished or ordered in accordance with a patient-specific
protocol approved by the treating or supervising physician.  A copy
of the section of the nurse practitioner's standardized procedure
relating to controlled substances shall be provided upon request, to
any licensed pharmacist who dispenses drugs or devices, when there is
uncertainty about the nurse practitioner furnishing the order.
   (g) The board has certified in accordance with Section 2836.3 that
the nurse practitioner has satisfactorily completed (1) at least six
month's physician and surgeon-supervised experience in the
furnishing or ordering of drugs or devices and (2) a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section.  The board shall establish the requirements for
satisfactory completion of this subdivision.
   (h) Use of the term "furnishing" in this section, in health
facilities defined in subdivisions (b), (c), (d), (e), and (i) of
Section 1250 of the Health and Safety Code, shall include (1) the
ordering of a drug or device in accordance with the standardized
procedure and (2) transmitting an order of a supervising physician
and surgeon.
   (i) Nothing in this section, nor any other provision of law, shall
be construed to authorize a nurse practitioner in solo practice to
furnish drugs or devices, under any circumstances.
   (j) "Drug order" or "order" for purposes of this section means an
order for medication which is dispensed to or for an ultimate user,
issued by a nurse practitioner as an individual practitioner, within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations.  Notwithstanding any other provision of law, (1) a drug
order issued pursuant to this section shall be treated in the same
manner as a prescription of the supervising physician; (2) all
references to "prescription" in this code and the Health and Safety
Code shall include drug orders issued by nurse practitioners; and (3)
the signature of a nurse practitioner on a drug order issued in
accordance with this section shall be deemed to be the signature of a
prescriber for purposes of this code and the Health and Safety Code.

  SEC. 2.  Section 2836.2 of the Business and Professions Code is
amended to read:
   2836.2.  Furnishing or ordering of drugs or devices by nurse
practitioners is defined to mean the act of making a pharmaceutical
agent or agents available to the patient in strict accordance with a
standardized procedure.  All nurse practitioners who are authorized
pursuant to Section 2831.1 to furnish or issue drug orders for
controlled substances shall register with the United States Drug
Enforcement Administration.
  SEC. 3.  Section 3502.1 of the Business and Professions Code is
amended to read:
   3502.1.  (a) In addition to the services authorized in the
regulations adopted by the board, and except as prohibited by Section
3502, while under the supervision of a licensed physician and
surgeon or physicians and surgeons approved by the board, a physician
assistant may administer or provide medication to a patient, or
transmit orally, or in writing on a patient's record or in a drug
order, an order to a person who may lawfully furnish the medication
or medical device pursuant to subdivisions (c) and (d).
   (1) A supervising physician and surgeon who delegates authority to
issue a drug order to a physician assistant may limit this authority
by specifying the manner in which the physician assistant may issue
delegated prescriptions.
   (2) Each supervising physician and surgeon who delegates the
authority to issue a drug order to a physician assistant shall first
prepare and adopt a written, practice specific, formulary and
protocols that specify all criteria for the use of a particular drug
or device, and any contraindications for the selection.  The drugs
listed shall constitute the formulary and shall include only drugs
that are appropriate for use in the type of practice engaged in by
the supervising physician and surgeon.  When issuing a drug order,
the physician assistant is acting on behalf of and as an agent for a
supervising physician and surgeon.
   (b) "Drug order" for purposes of this section means an order for
medication which is dispensed to or for a patient, issued and signed
by a physician assistant acting as an individual practitioner within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations.  Notwithstanding any other provision of law, (1) a drug
order issued pursuant to this section shall be treated in the same
manner as a prescription or order of the supervising physician, (2)
all references to "prescription" in this code and the Health and
Safety Code shall include drug orders issued by physician assistants
pursuant to authority granted by their supervising physicians, and
(3) the signature of a physician assistant on a drug order shall be
deemed to be the signature of a prescriber for purposes of this code
and the Health and Safety Code.
   (c) A drug order for any patient cared for by the physician
assistant that is issued by the physician assistant shall either be
based on the protocols described in subdivision (a) or shall be
approved by the supervising physician before it is filled or carried
out.
   (1) A physician assistant shall not administer or provide a drug
or issue a drug order for a drug other than for a drug listed in the
formulary without advance approval from a supervising physician and
surgeon for the particular patient.  At the direction and under the
supervision of a physician and surgeon, a physician assistant may
hand to a patient of the supervising physician and surgeon a properly
labeled prescription drug prepackaged by a physician and surgeon,
manufacturer as defined in the Pharmacy Law, or a pharmacist.
   (2) A physician assistant may not administer, provide or issue a
drug order for Schedule II through Schedule V controlled substances
without advance approval by a supervising physician and surgeon for
the particular patient.
   (3) Any drug order issued by a physician assistant shall be
subject to a reasonable quantitative limitation consistent with
customary medical practice in the supervising physician and surgeon's
practice.
   (d) A written drug order issued pursuant to subdivision (a),
except a written drug order in a patient's medical record in a health
facility or medical practice, shall contain the printed name,
address, and phone number of the supervising physician and surgeon,
the printed or stamped name and license number of the physician
assistant, and the signature of the physician assistant.  Further, a
written drug order for a controlled substance, except a written drug
order in a patient's medical record in a health facility or a medical
practice, shall include the federal controlled substances
registration number of the physician assistant.  The requirements of
this subdivision may be met through stamping or otherwise imprinting
on the supervising physician and surgeon's prescription blank to show
the name, license number, and if applicable, the federal controlled
substances number of the physician assistant, and shall be signed by
the physician assistant.  When using a drug order, the physician
assistant is acting on behalf of and as the agent of a supervising
physician and surgeon.
   (e) The medical record of any patient cared for by a physician
assistant for whom the supervising physician and surgeon's drug order
has been issued or carried out shall be reviewed and countersigned
and dated by a supervising physician and surgeon within seven days.
   (f) All physician assistants who are authorized by their
supervising physicians to issue drug orders for controlled substances
shall register with the United States Drug Enforcement
Administration (DEA).
  SEC. 4.  Section 4040 of the Business and Professions Code is
amended to read:
   4040.  (a) "Prescription" means an oral, written, or electronic
transmission order that is both of the following:
   (1) Given individually for the person or persons for whom ordered
that includes all of the following:
   (A) The name or names and address of the patient or patients.
   (B) The name and quantity of the drug or device prescribed and the
directions for use.
   (C) The date of issue.
   (D) Either rubber stamped, typed, or printed by hand or typeset,
the name, address, and telephone number of the prescriber, his or her
license classification, and his or her federal registry number, if a
controlled substance is prescribed.
   (E) A legible, clear notice of the condition for which the drug is
being prescribed, if requested by the patient or patients.
   (F) If in writing, signed by the prescriber issuing the order, or
the physician assistant or nurse practitioner who issues a drug order
pursuant to Section 3512.1 or 2836.1.
   (2) Issued by a physician, dentist, optometrist, podiatrist, or
veterinarian, or, if a drug order is issued pursuant to Section
3502.1 or 2836.1, by a physician assistant or nurse practitioner
licensed in this state.
   (b) Notwithstanding subdivision (a), a written order of the
prescriber for a dangerous drug, except for any Schedule II
controlled substance, that contains at least the name and signature
of the prescriber, the name or names and address of the patient or
patients in a manner consistent with paragraph (3) of subdivision (b)
of Section 11164 of the Health and Safety Code, the name and
quantity of the drug prescribed, directions for use, and the date of
issue may be treated as a prescription by the dispensing pharmacist
as long as any additional information required by subdivision (a) is
readily retrievable in the pharmacy.  In the event of a conflict
between this subdivision and Section 11164 of the Health and Safety
Code, Section 11164 of the Health and Safety Code shall prevail.
   (c) "Electronic transmission prescription" includes both image and
data prescriptions.  "Electronic image transmission prescription"
means any prescription order for which a facsimile of the order is
received by a pharmacy from a licensed prescriber.  "Electronic data
transmission prescription" means any prescription order, other than
an electronic image transmission prescription, that is electronically
transmitted from a licensed prescriber to a pharmacy.
   (d) The use of commonly used abbreviations shall not invalidate an
otherwise valid prescription.
   (e) Nothing in the amendments made to this section (formerly
Section 4036) at the 1969 Regular Session of the Legislature shall be
construed as expanding or limiting the right that a chiropractor,
while acting within the scope of his or her license, may have to
prescribe a device.
  SEC. 5.  Section 4060 of the Business and Professions Code is
amended to read:
   4060.  No person shall possess any controlled substance, except
that furnished to a person upon the prescription of a physician,
dentist, podiatrist, or veterinarian, or furnished pursuant to a drug
order issued by a physician assistant pursuant to Section 3502.1 or
a nurse practitioner pursuant to Section 2836.1.  This section shall
not apply to the possession of any controlled substance by a
manufacturer, wholesaler, pharmacy, physician, podiatrist, dentist,
veterinarian, physician assistant, or nurse practitioner, when in
stock in containers correctly labeled with the name and address of
the supplier or producer.
   Nothing in this section authorizes a nurse practitioner or a
physician assistant to order his or her own stock of dangerous drugs
and devices.
  SEC. 6.  Section 4174 of the Business and Professions Code is
amended to read:
   4174.  Notwithstanding any other provision of law, a pharmacist
may dispense drugs or devices upon the drug order of a nurse
practitioner functioning pursuant to Section 2836.1 or a certified
nurse midwife functioning pursuant to Section 2746.51, a drug order
of a physician assistant functioning pursuant to Section 3502.1, or
the order of a pharmacist acting under Section 4052.
  SEC. 7.  Section 11026 of the Health and Safety Code is amended to
read:
   11026.  "Practitioner" means any of the following:
   (a) A physician, dentist, veterinarian, podiatrist, or pharmacist
acting within the scope of a project authorized under Article 1
(commencing with Section 128125) of Chapter 3 of Part 3 of Division
107, a registered nurse acting within the scope of a project
authorized under Article 1 (commencing with Section 128125) of
Chapter 3 of Part 3 of Division 107, a nurse practitioner acting
within the scope of Section 2836.1 of the Business and Professions
Code, or a physician assistant acting within the scope of a project
authorized under Article 1 (commencing with Section 128125) of
Chapter 3 of Part 3 of Division 107 or Section 3502.1 of the Business
and Professions Code.
   (b) A pharmacy, hospital, or other institution licensed,
registered, or otherwise permitted to distribute, dispense, conduct
research with respect to or to administer a controlled substance in
the course of professional practice or research in this state.
   (c) A scientific investigator, or other person licensed,
registered, or otherwise permitted, to distribute, dispense, conduct
research with respect to, or administer, a controlled substance in
the course of professional practice or research in this state.
  SEC. 8.  Section 11150 of the Health and Safety Code is amended to
read:
   11150.  No person other than a physician, dentist, podiatrist, or
veterinarian, or pharmacist acting within the scope of a project
authorized under Article 1 (commencing with Section 128125) of
Chapter 3 of Part 3 of Division 107, a registered nurse acting within
the scope of a project authorized under Article 1 (commencing with
Section 128125) of Chapter 3 of Part 3 of Division 107, a nurse
practitioner acting within the scope of Section 2836.1 of the
Business and Professions Code, a physician assistant acting within
the scope of a project authorized under Article 1 (commencing with
Section 128125) of Chapter 3 of Part 3 of Division 107 or Section
3502.1 of the Business and Professions Code, or an out-of-state
prescriber acting pursuant to Section 4005 of the Business and
Professions Code shall write or issue a prescription.
  SEC. 9.  This act is intended solely to conform state law to the
federal Controlled Substances Act, and nothing in this act is
intended to increase the scope of practice of physician assistants or
nurse practitioners.
